Senior Consultant in Cybersecurity advising clients on EU cyber and digital compliance requirements. Collaborating with a team of experts to implement regulatory frameworks and solutions.
About the role
- Senior Manager of Medicare Compliance at CVS Health overseeing Medicare compliance initiatives and operations. Leading oversight of delegated functions and engaging with internal stakeholders for compliance control.
Responsibilities
- Execute the Medicare FDR Oversight Program, with primary responsibility for oversight of Organization Determination, Appeals and Grievances (ODAG) delegated functions.
- Provide compliance and operational oversight of delegated organization determination functions, applying clinical knowledge and judgment to assess medical management practices, regulatory adherence, and risk mitigation effectiveness.
- Own and execute auditing, monitoring, validation, and corrective action plan (CAP) oversight activities aligned within the Medicare Compliance Work Plan.
- Identify, prioritize, and escalate compliance risks; conduct root cause analysis; and support timely, sustainable remediation with internal and external partners.
- Serve as a subject matter expert on Medicare FDR oversight, maintaining current knowledge of CMS guidance, HPMS memos, and contractual requirements.
- Partner with internal stakeholders and delegated entities to strengthen compliance controls and promote consistent, compliant outcomes.
- Utilize compliance tools and systems, including Medicare eGRC platforms (e.g., Archer) and Microsoft applications, to support oversight, documentation, monitoring, and reporting.
- Support broader Medicare Compliance initiatives and projects as assigned.
Requirements
- 7+ years of experience in healthcare, or Medicare Advantage program compliance or regulatory work
- 2+ years of experience independently leading complex compliance, risk, or regulatory initiatives
- Excellent written and verbal communication skills with strong analytical capabilities
- Ability to travel up to 10% (including plane)
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources
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